Solving The ‘No-Show’ Patient Dilemma

Patient no-shows are a daily scheduling occurrence. Why do they happen and what can we do to prevent them?   

Why do no-shows happen? Reasons for no-shows revolve around many things, ranging from an unavoidable last-minute conflict or an unfortunate mishap to patients just forgetting, being too busy or too lazy to call, or just thinking it is not a priority. If we simply sit back and disregard these occurrences without imposing any consequence, we enable them in diminishing the value of our time. The result? Unwanted holes in our schedule causing disruption, frustration and lost revenue. Instead of accepting their irresponsible behavior or merely complaining, how about we take control and do something about it?

What can we do to prevent no-shows? First, we need to attach value to the visit. If patients do not fully understand why they need to return, it will not be important to them and “no big deal” if they miss it. Besides, if they suspect they are being rescheduled for a follow-up just so we can squeeze another co-pay out of them, they really will dismiss it. It is up to each person in the office — beginning with the doctor and reinforced by the clinical assistant — to impress upon our patients that a follow-up appointment is in their best interest, not ours. 

Second, the receptionist needs to be proactive when scheduling the patient’s appointment, emphasizing that the patient needs to call if he or she cannot make it. “Mrs. Smith, if you cannot keep this appointment, we would appreciate a courtesy call so we can then offer that time to someone who is waiting to get in. We realize your time is important and should the situation ever arise where you would need to be seen, we would of course give you the same consideration.” 

Third, in addition to reinforcing this message that our time is valuable, we need to appreciate that patients’ time is valuable too. Imagine the mixed message we send when scheduling two or more appointments in the same time period. (Don’t be so naïve to assume that they don’t compare times with each other while they are sitting in your reception area.) You cannot expect a patient not to realize that you double booked another patient during a time that is supposedly reserved for him or her, sometimes forcing the patient to wait an additional 30 minutes (or more) before he or she sees the doctor. If patients do not show at their next appointment time, it may be they have a guilt-free assumption that you have someone else filling that time slot anyway.

Fourth, initiate a patient reminder call system and be sure to ask where you can best reach patients. Maybe they prefer a text or an email rather than a phone call. We can argue that there are still the occasional no-shows even with a reminder call, but the truth is there are far less than without it. There is a new app about to emerge from www.mylocalbeacon.com that will offer patients waiting to be seen instant connectivity via their mobile device when an opening appears in the schedule. This technology will effectively replace the standardized, paper “wait list” and help fill those last-minute holes in the schedule.

Fifth, inform your patients that the practice will be charging a fee for those who do not show or cancel without giving 24 hours’ notice. It is necessary to point out that the purpose is not a revenue source. It is an incentive, not a punishment, designed to convert poor behavior into good. Practices that have initiated this policy stand by its success in reducing no-shows. Always remember that if you set a new policy, you need to educate your patients about it prior to enforcing it.

However you choose to deal with patients who repetitively cancel, change or break their appointments, do not forget to follow up with a phone call to them for completeness of care. Staff need to document and date these calls, the patient’s response, their reason for not showing as well as their rescheduled date (if they choose to make one). Remember, if you did not document it, you did not do it and that can come back to haunt you one day.